Mitigating the uncertainty in small field dosimetry by leveraging machine learning strategies.

Small field dosimetry is significantly different from the dosimetry of broad beams due to loss of electron side scatter equilibrium, source occlusion, and effects related to the choice of detector. However, use of small fields is increasing with the increase in indications for intensity-modulated radiation therapy and stereotactic body radiation therapy, and thus the need for accurate dosimetry is ever more important. Here we propose to leverage machine learning (ML) strategies to reduce the uncertainties and increase the accuracy in determining small field output factors (OFs). Linac OFs from a Varian TrueBeam STx were calculated either by the treatment planning system (TPS) or measured with a W1 scintillator detector at various multi-leaf collimator (MLC) positions, jaw positions, and with and without contribution from leaf-end transmission. The fields were defined by the MLCs with the jaws at various positions. Field sizes between 5 and 100 mm were evaluated. Separate ML regression models were generated based on the TPS calculated or the measured datasets. Accurate predictions of small field OFs at different field sizes (FSs) were achieved independent of jaw and MLC position. A mean and maximum % relative error of 0.38 ± 0.39% and 3.62%, respectively, for the best-performing models based on the measured datasets were found. The prediction accuracy was independent of contribution from leaf-end transmission. Several ML models for predicting small field OFs were generated, validated, and tested. Incorporating these models into the dose calculation workflow could greatly increase the accuracy and robustness of dose calculations for any radiotherapy delivery technique that relies heavily on small fields.